HomeMy WebLinkAboutDriveway Street Cut Permits 133 Cliffwoo Permit No. 2644 Town of South Windsor, CT
Date 04/05/1999 Street Excavation Permit
Expiration Date 04/04/2000
Descrip:
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Applicant f �� a � � Location
Name BOUTIN & SONS {b,OD DRIVE
Addr. 121 WINDSORVILLE
BROAD BROOK CT 06R 6 hype ' f i* bRIVEWAY
Phone (860)623-2526 `'
Applicant agrees io „ >`tP�` cf S 0{ ytisor the amount of bond
required and to reimbuiep h rw fir any expenses
.incurred by the Town 'f a � �1h connection with this
permit and that app1i ; X1Y bide by the rules and
regulations for permiSouth Windsor's Street
Cut Permit Manual .
* * PEf�MIT TO { ` � ALL TIMES.
Issued by - t Tle
Date Completed �' Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm c f Phone No.
Address of Firm J�
Location of proposed work
Describe fully nature of permit requested 1.1 A
Starting date Approx. time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut Q
Indicate North Prop. size of cut &�,��.
No. cuts
Cf Amt. of Deposit S by
f () Cash() Check#
^J Cut size after Perm. Patch
No. Cuts
Final Billing S
Amt. Due Payee S
Amt. Due Town 6
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO RQMBURSE THE TOWN OF
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUT. WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:%Rz a- /Zei 01
Title: �/ D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES